Study objective. A health economic analysis was undertaken to quantify the economic consequences of acute rejection and serious adverse events in patients receiving induction with rATG (Thymoglobulin^®) vs the monoclonal antibody basiliximab (Simulect^®) during the first year after kidney transplantation (tx).

Methods. Health economic data to year 1 post-tx were derived from current costs at 3 German centers and applied to the database from a randomized trial of 278 patients (Brennan DC et al. N Engl J Med 2006; 355: 1967-77). A 4-state Markov model was applied to analyze transitions between health states (never transplanted, alive/functioning graft, alive/graft failure, and dead), and quality-adjusted life years (QALYs) were calculated.

Results. Mean treatment cost for each induction regimen in year 1 was [euro]5,378 per patient more for rATG than basiliximab ([euro]7,792 vs [euro]2,414). Mean cost for management of rejection was lower under rATG vs basiliximab ([euro]471 vs [euro]1,515, p=0.02). Costs associated with managing delayed graft function, graft failure, and dialysis after graft failure were numerically lower in the rATG group; infection treatment costs were virtually identical. At 1 year post-tx, 91% vs 88% of grafts were functioning in the rATG and basiliximab groups, respectively (p=0.40), incurring higher routine graft maintenance costs in the rATG cohort ([euro]8,905 vs [euro]8,539, p=0.34). The total estimated 12-month treatment cost was [euro]85,306 with rATG vs [euro]83,144 with basiliximab (p<0.01). Due to improved graft survival under rATG, costs per patient were projected to be [euro]514 lower at 2 years, and [euro]4,405 lower at 10 years, using rATG basiliximab. The initial utility difference of 0.007 QALYs per patient for rATG versus basiliximab increased to 0.096 QALYs by year 10 post-tx.

Conclusion. The higher treatment cost for rATG vs basiliximab is partly offset during the first year after kidney tx by lower costs for managing rejection and other adverse events. After year 1, a lower rate of return to dialysis in rATG-treated patients results in a QALY advantage and a substantial cost reduction versus basiliximab, which increases over time post-tx.

CITATION INFORMATION: Cremaschi L, Thissen R, Benzing T, Wiesener M, Zink N, Paivanas T, Reitan J, Gallagher M, Thaiss F. Induction Therapy with Rabbit Antithymocyte Globulin (rATG, Thymoglobulin^®) vs Basiliximab After Kidney Transplantation: A Health Economic Analysis from a German Perspective. Am J Transplant. 2016;16 (suppl 3).

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